Pressure tolerance question

[TheTwinsMom1]

Hi,

I have been on CPAP since March 29, 2010. I was prescribed a pressure of 8, but my doctor ordered me an APAP so i could tweak my pressures myself. He is a great doctor .

Well I had a question, I started off with 8-13 and I was finding I was hitting max pressure alot and was still very very sleepy everyday. So a few days ago I opened my pressure wide open from 8-20 just to see. I notice I am hitting 14 quite a bit.

Is it normal to have your pressure go up so quickly or do you sort of build up a tolerance to the different pressures and then need to go up? I should mention, I only have apneas while in REM sleep.

Jaimie

[LinkC]

I doubt your optimal pressure "went up so quickly" at all. My guess is you were titrated incorrectly and needed 14 all along. I assume you have mask leaks under control?

Generally speaking, once you find your optimal pressure, it won't change at all unless you have weight gain/loss or some other significant change. Once it settles, I would recommend a fairly tight range (say -2/+1 from your 90% pressure). If the range is too wide, you'll get unnecessary events as the machine ramps up to your optimal pressure. In fact, I run straight CPAP at my optimal, rather than APAP. I use APAP for a few nights every few months just to make sure nothing has changed.

[Goofproof]

Odd's are The pressure they originally guess at was incorrect. You have the software so your dailies, should show, where you need to be at. Your pressure doesn't change over time, it's determined by your needs.

Your leak rate needs to be under control to keep your treatment good and the data valid. (39 or under) No large leaks. Jim

You would be better served if you had your profile in text form.

[TheTwinsMom1]

Ok, fixed profile to show text.

My leak rate from Rescan for the last month is as follows:

Median: 0.0
95th %: 0.0
Max: 21.6

I think you were right and I was just set too low. I ended up calling my sleep clinic and they want me to stay on the wide pressure for another week and then bring my card in for double checking.

[Hawthorne]

It often takes a week or even more for everything to adjust so you should not make changes too quickly.

Your titration pressure may very well have been too low. That happens a lot of times. Are you getting your 90% pressure from the LCD screen or do you have software? Software readings are more accurate, in my experience.

If it were me, and I'm no expert, I would leave things at 8-20 for week and see what your 90% is each day and get a weekly average. I might then set a narrower range a, 1 or 2 cm below my average 90% as a minimum and 1 or 2 cm over the average 90% for a maximum.

As others have said, be sure your leak rate is good as well. With a higher pressure, there may be new issues there.

I see you posted some leak infor while I was replying and it looks like you have software.

[TheTwinsMom1]

Yes, I am using Rescan 3.10 and that is where I am getting my info from. I am planning on leaving it on 8-20 for a week or so and see what my 95% pressure is.

[semreka]

Hi,

I have been on CPAP since March 29, 2010. I was prescribed a pressure of 8, but my doctor ordered me an APAP so i could tweak my pressures myself. He is a great doctor .

Well I had a question, I started off with 8-13 and I was finding I was hitting max pressure alot and was still very very sleepy everyday. So a few days ago I opened my pressure wide open from 8-20 just to see. I notice I am hitting 14 quite a bit.

Is it normal to have your pressure go up so quickly or do you sort of build up a tolerance to the different pressures and then need to go up? I should mention, I only have apneas while in REM sleep.

Jaimie

First of all if you do not have any risk related with predetermined illness of your heart or lungs , you do not need to have an upper limit for your pressure range.(keep as the maximum alowed for your machine)
The more important figure is the lower limit, because if it is below the needed value for preventing the collapse in your throat , the air flow can not restrain the relaxed tissue of your throat.
It will cause partial collapse (hypopnea ) or complete collapse (apnea) .
So changing the upper limit usesless , because ,if not needed the machine in Auto mode never reaches to limit values .
You should change your lower limit step by step. You can add 0.5 cm H2O per each step.(each step is one night )
You should observe decrease in your AHI by doing this.
When you get the AHI below 6 stop rising the pressure and continue with this pressure 4-5 nights , the decrease in AHI will continue due to your increasing adaptation to this pressure by time.
If decrease is continues you are in the right way.
And if AHI is below 5 , you are succeeded.
But you should be careful about not to have a very big lower limit. it is better to have it below 10 . Because above this value you may have exhaling difficulties.(If it exceeds 10 - 12 , the Bipap may be more sufficient)
There are some more tricks but I do not want to confuse you.
It is better to solve the problems step by step if you face with difficulties, please feel free to write to me.
Good Luck .........
God Bless......